Yelling Doctors, How do you handle them?????

Tom123 · Mar 14, 2009

I would not have called the physician at that time, based only on the need to know the dosage of a med, that was not taken. I think you probably had orders for other antibiotics, IV probably. It is like calling the doctor at 1 AM for a sleeping pill or a laxative. Don't do it.

But about yelling doctors. This physician would have yelled if he were the admitting physician, and the patient was in a crisis. I handle this a couple of ways.

1. I hang up the phone and page the doctor again. I then tell him/her how sorry I am for having been cut off. If he starts yelling again, I just make comment that I am quoting him in the nursing notes. If he does not wish to address these issues, I will contact my supervisor, and have him/her handle the situation. In these cases, I have usually called to Chief of the Service. If that does not help, I call the Chief of Staff. That usually gets results. I do this as the supervisor.

2. If the physician gives me a minute to speak, I try to explain the necessity of why I had to call him/her. I even let them know that it is hospital policy. I am bound by hospital policy. If he/she continues not to listen, I return to option #1, and work my way up the chain of command.

Hopefully you have a very supportive Nurse Manager, and a supportive Nurse Executive. That always helps.

RN Randy · Mar 14, 2009

The OP stated that calling is her facility's policy, so I don't think it was very kind of you to call her rude and inappropriate. If that is the policy, then she is wise in following it. They don't make them so nurses can pick and choose which ones to follow. There's a big difference between a nurse and a telemarketer.
That being said, if it were my facility's policy (thank goodness it's not!), is it acceptable to wait until a "decent" hour to call for med recs, like 0600?

er..... did you even read the OP?

A new nurse said it was 'policy to clarify meds on admission'...

HOW do you get 'policy to call the doc immediately, regardless of the hour' out of that... ??

The rest of us got:

'I'm new and we have to do a med rec on new admits and I was afraid to not fill out every box because [insert reason]'.

You know, new-nurse-ophobia... ? It's pretty common.

Sounds like any other facility admit. Do a med rec.... find the missing pieces. An old nurse would have just snagged it elsewhere at some point.

A simple noob mistake that happened to fall into the lap of an emotional moron.

Either way, it's not even the point or the question, so let's not call the kettle black so quickly.

RN Randy · Mar 14, 2009

Bingo. If this wasn't the admitting physician, there was no reason to call that late. It's just completely inappropriate. This isn't a case of a "rude doctor", it's a rude nurse. Would the OP have called a family member that late to ask the same question? And I wonder, if a telemarketer had called the OP that late, if maybe they wouldn't have done a little yelling too?

Well, I usually agree with your posts, but I'm gonna call you on this one.

It was a newbie mistake with a rude dude, not a rude nurse. [if she did this continually, yeah, maybe he could be frustrated or whatever, but STILL... two rudes don't make a right.]

It's just plain childish to have fits like that. You can say anything you want to convey your desire to be let alone, but this yelling/tantrum thing I just don't get, and never will.

rb

miko014 · Mar 14, 2009

I would not have called the physician at that time, based only on the need to know the dosage of a med, that was not taken. I think you probably had orders for other antibiotics, IV probably. It is like calling the doctor at 1 AM for a sleeping pill or a laxative. Don't do it.

That's an awful lot to assume. I'm giving the OP the benefit of the doubt that she knows that you don't need to worry about the PO abx if they ordered them IV.

1) The op clearly states IT WAS NOT YET 11PM - how much earlier it was I don't know, but it was earlier.

2) She also states that the physician she called was the ADMITTING PHYSICIAN and was ON CALL.

3) There is also a lot of assumption that the pt is just on abx for the fun of it. IT DEPENDS WHAT THE ABX WERE FOR AND WHAT TIME IT ACTUALLY WAS to determine if the call was appropriate. All he needed to do was say, "no, you can hold the abx" or "oh yeah, she was on keflex? Go ahead and order Xmg PO X times daily."

4) Yes a more seasoned nurse might not have made this decision, but we don't know all of the facts, and even if she did call at 2300 for a PO antibiotic, she did not deserve to be yelled at.

treeBranch · Mar 14, 2009

:yawn: I am a doctor and how dare you call me for clarification of patient orders. :banghead: After all that is why I employ an ARNP in my office and to bother me about a dose of a medication that was omitted is just absurd, after all -- your first shift can handle it. Learn to email them :typing and let me rest...

:bow:Yes Sir.

Okay, I do not know all of the facts involving this scenario - other than the briefly written post asking what to do if a doctor yells at you. :cry: (NOT!!!!)

Simple. Use your de-escalating skills. Receive the order to its completion. Document the call and ommission of completed order as to the reason for the doctor contact. And most importantly, and please keep this powerful tool in mind --- WRITE UP AN INCIDENT REPORT ---- it is a medication error --- but not the nurse's. Do not forget to add the abusive language as part of the report and to whom you shall report this in the morning.

The reason an incident report is important is because it will need to be addressed by upper management and if this doctor continues to verbally abuse on the telephone - in reality - it may cause the nurse to be hindered from calling the doctor because he/she does not want the verbal abuse and ultimately undermine patient care. This gives the facility a tracking mechanism. :up:

To the nurse :nurse: that wrote this thread. You did your job, within your scope of practice, standard operating procedures, and acted as a patient advocate. Good job - keep up the good practice. :saint:

lovehospital · Mar 15, 2009

One sentence for you doc take a deep breath and relax cause I'm THAT one person who covers your gluteus maximus:) :) :)

Bella RN, BSN, MSN · Mar 15, 2009

I have been in that situation and I have lauged at them(literally) :Dand said sternly"sir are you done--I need to clarify this order you have written..." some have asked me what is so funny and I just replied "Sir I am laughing at you because I just need a simple clarification for antibiotic, may I have it please--:yawn:saying it sweet but letting them know at the same time I am not apologetic about this ---:rolleyes:I am doing my job. And then they just give me the clarification and thats it.

Don't let any MD--whether they have a rep of being a bully or not; bully you on the phone or in person!!! :no:

Hold your head up high and and do your job well...which i know you do!!! :wink2: I notice that some doctors get nervous when they see confident assertive nurses.... :yeah:

Last week I was in the unit and reported a critical lab result to a pulmonogist in person who is known to be crabby--I stated the result to him--and he says to me "I don't give a rat's ass about that because I didnt write that order-- So I looked at him like he was crazy and I said--"since you don't give a rat's ass I will document it as such" and turned around to grab the chart--then he back peddled and was like well what i meant was blah blah blah...he looked at my badge several times and from that point he realized "OH she is one of those..."and I have NEVER had a problem with him since.

So you learn and grow with each situation...You will do fine sweetie!! :up:

dede1956 · Mar 15, 2009

I have been in the business for over 32 yrs and yes, have had many physicians yell at me. Some of them are yelling just to vent their frustration over the situation, some yell because they know that they can do it and get away with it. Do I yell back, no...I have though told the doctor that when he/she can talk to me in a calm and professional manner than I will be more than happy to talk. I have also hung up on a doctor, softly of course, and when they realize that they are talking to a disconnnected line they usually call back and ask what happened...and I tell them that I am not their verbal punching bag, I was calling because of a problem with their pt and if they don't want to handle the problem then please consult the hospitalist to see the pt and fix the problem. I have no problem with walking away from them while telling them I will be back when they can hold a conversation in a calm voice, that I don't make the policy and if they are having a problem with the policy then this is the one(s) that they need to address it with. What I do not do is appologize for calling them. It is their responsibility to look at the orders to make sure everything is there, and this does include the med rec!!! We do have some of our docs come to us and say "is there anything else I need to order or that you want?" That helps and makes both of our jobs so much easier and 99.9% pacifies the patient.

Sorry doc you make soooo much more $$ than I ever will, or have, and if you are upset that a nurse, new or otherwise, is calling you because the policy dictates then maybe take the hint from above and look at what is ordered, med rec, AND ask the nurse if there is anything else we/pt need. Curtesy and respect go both ways!!!!

Tom123 · Mar 15, 2009

That's an awful lot to assume. I'm giving the OP the benefit of the doubt that she knows that you don't need to worry about the PO abx if they ordered them IV.
1) The op clearly states IT WAS NOT YET 11PM - how much earlier it was I don't know, but it was earlier.
2) She also states that the physician she called was the ADMITTING PHYSICIAN and was ON CALL.
3) There is also a lot of assumption that the pt is just on abx for the fun of it. IT DEPENDS WHAT THE ABX WERE FOR AND WHAT TIME IT ACTUALLY WAS to determine if the call was appropriate. All he needed to do was say, "no, you can hold the abx" or "oh yeah, she was on keflex? Go ahead and order Xmg PO X times daily."
4) Yes a more seasoned nurse might not have made this decision, but we don't know all of the facts, and even if she did call at 2300 for a PO antibiotic, she did not deserve to be yelled at.

I must ask the question -- Was an experienced RN available for consultation -- or how about the Nursing Supervisor?

I agree whole heartedly, NO physician has the right to yell at a nurse. It is actual hospital policy to call a physician for medication reconcilation, on admission, then the young nurse had no choice. But due to the hour, maybe some critical thinking is needed. My experience has been that ALL medications are cancelled upon admission. Therefore, new orders must be written. I know I have only been in the business for 44 years, but what physician is responsible for writing the admission orders? Is there a hospitalist in the house?

There has to be some other course of action that could have been taken. I would love for the young nurse to copy the policy for all of us to see. That would clarify most of the questions everyone has, and also let us know the diagnosis, why was the patient admitted? Answers can be given more appropriately if all of the facts are on the table.

RN Randy · Mar 15, 2009

I must ask the question -- Was an experienced RN available for consultation -- or how about the Nursing Supervisor?
I agree whole heartedly, NO physician has the right to yell at a nurse. It is actual hospital policy to call a physician for medication reconcilation, on admission, then the young nurse had no choice. But due to the hour, maybe some critical thinking is needed. My experience has been that ALL medications are cancelled upon admission. Therefore, new orders must be written. I know I have only been in the business for 44 years, but what physician is responsible for writing the admission orders? Is there a hospitalist in the house?
There has to be some other course of action that could have been taken. I would love for the young nurse to copy the policy for all of us to see. That would clarify most of the questions everyone has, and also let us know the diagnosis, why was the patient admitted? Answers can be given more appropriately if all of the facts are on the table.

Huh? Ok, so how about what chair was she sitting in? The charge nurse's? Was she hindering the CN from doing something, and did said CN give her a dirty look, which caused her to lose focus and not really realize what time it was?

SO, the real question is:

what do you call a boomerang that doesn't work....?

A stick.

Now if I only had a dead horse... :)

dede1956 · Mar 15, 2009

There are a lot of questions about the policy, admitting dx, who else was available for the new nurse. We all need to remember that critical thinking comes with time and is not something that occurs overnight. Also and most important is the new JCAHO quidelines for 2009 called WORK PLACE VIOLENCE. What the doc did can be looked at as work place violence. No one and I do mean NO ONE deserves to be yelled at, I don't care what time it is. Unfortuneately this new nurse will probably be very reluctant to call this doctor again in the future whether it is for an antibiotic or something more important. The manager needs to get involved listening to the nurse and then getting the docs side and trying to get a solution that will work for both the nursing staff and the doc. We do need each other...docs admit and it keeps us working, on the flip side the docs need us because we are his eyes and ears when he/she is not here. It doesn't do anyone any good when one party is rude to the other, important info gets missed or not passed on and ultimately the patient is the one that suffers!!!

nerdtonurse?, BSN, RN · Mar 15, 2009

I had a doc that was shrieking at me one time because the pt has a bad outcome (well, gee, if 1--you didn't order a pre-op antibiotic, and 2--dayshift didn't catch it and call you, and 3--now the pt has a raging infection, and 4--I just got here and haven't even seen the pt yet, and you're screaming at ME because the pt's temp is 104.3 and the wound is draining purulent goopy stuff??). I just stood there while he yelled, and didn't say a word. When he finally stopped, I looked him dead in the eye and said, "Are you finished now? I'd like to put my purse down."